In 1972 disease patterns in selected representative areas of Transkei and Ciskei were surveyed. Some of the findings are presented

Kloppers, P.J.

Solleder, G.

van der Walt, E

English

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568 SA MEDIESE TYDSKRIF DEEL 63 9 APRIL 1983Disease patterns in Transkei and CiskeiE. VAN DER WALT, P. J. KLOPPERS, G. SOLLEDERTABLE I. CATEGORIES OF DISEASE - PREVALENCESummaryIn 1972 disease patterns in selected representativeareas of Transkei and Ciskei were surveyed. Someof the findings are presented.S Atr Med J 1983; 63: 568-570.CategoriesDiseases of the digestive systemCommunicable diseasesDiseases of the respiratory systemDiseases of the skin and cellular tissueTraumaNutritional diseaseTotalMales(%)22,421,620,27,77,5~83,7Females(%)18,217,822,77,63,94,674,8In 1972 the Transkei and Ciskei Research Society undertook theambitious task of attempting a survey of disease in Transkei andCiskei. The results later appeared as a special publication of theUniversity of Pretoria, A Survey of Disease Patterns in Transkeiand the Ciskei. I A shortened and edited version reproduced tomake the information more widely available to healthprofessionals follows.The data collected are ofconsiderable importance in recordingthe disease profiles of communities living in distant (mainlyrural) parts of the subcontinent and of peoples who to a greater o'rlesser extent still adhere to the traditional lifestyles and eatinghabits of their forebears. Rapid change, urbanization andwesternization are the order 'of the day, and the advent ofindependence and self-government for the states ofTranskei andCiskei has, predictably, accelerated this change.Patients and methodsIndividuals surveyed were classified into the following threesocial groups: (i) 'blanket' group - (42,5%) those mainly abidingby their traditional customs and who usually wore a blanket asclothing, the colour and style of which have social connotations;(ii) 'school' group (52,5%) - those who had been or were goingto school, who dressed in Western-type clothes, and hadassumed some of the habits associated with the Western lifestyle;(iii) 'urban' group (5%) - those who had discarded most of theirtraditional customs and had a predominantly Western lifestyle.The smallness of the proportion (5%) thought to be urbanizedshould be stressed.Although 8684 patients were seen at 12 widespread hospitalpoints over a 2-week period in the summer of 1972 diseases wereclassified according to the 8th revision of the InternationalClassification of Diseases of 1965; the most prevalent categoriesare listed in Table I. The most commonly occurring diseases ineach age group are listed in Tables H and HI.ResultsIn the 'blanket' group nutritional and communicable diseases(especially tuberculosis) and mental disorders (possibly ofHans Snyckers Institute, University of PretoriaE. VAN DER WALT, .\1.B. CH.B.P. J. KLOPPERS, .\I.D., FRCP, Co-DirectorTranskei and Ciskei Research Society, TranskeiG. SOLLEDER, M.D.,Honorary Secretarynutritional origin) were the main diseases, while in the 'urban'group obesity, diabetes and allergies were the main diseases. Inthe 'school' group there was a high incidence of boils, impetigo,genito-urinary disease and anaemia; males often suffered" fromtrauma and there was a higher incidence of upper respiratory andgenito-urinary infections.Diseases of the respiratory system. The commonestfound were acute conditions of the upper respiratory tract -colds, tonsillitis, pharyngitis, sinusitis, laryngitis, and tracheitis.Pulmonary tuberculosis was not classified with respiratorydiseases but with communicable diseases, and accounted for8,8% of all diseases reported among males and 7,2% amongfemales.Transkei silicosis is a fibrotic, silicotic lesion of the lungswhich affects only females and is considered to be a 'dust disease'resulting from the grinding of maize on stones inside the hur.2 .3Thirty cases (0,3%) were seen.Digestive diseases. Nearly 20% of all diseases were of thedigestive tract, 78% occurring in children up to 9 years of age;gastro-enteritis was the most prevalent disease here in all socialgroups. Notable is the absence of peptic ulceration, gallstones,hiatus he mia, diverticulitis, carcinoma of the colon, polyps of thecolon, haemorrhoids and appendicitis.Communicable diseases were the 2nd most commonlyreported category among males and the 3rd among females.Almost 50% of these patients had tuberculosis; ± 15% hadmeasles, 9% roundworm and 4% venereal disease.Diseases of the skin and cellular tissue. Scabies, the chiefcomponent of this category (30%), appeared to affect femalesmore than males, and was particularly prevalent in the 'school'group. Impetigo, boils and carbuncles, cellulitis and most otherdiseases in this category were also markedly. more frequent infemales of the 'school' group. Boils and carbuncles occurredrelatively often in the urban group, as did dermatitis andcellulitis.Ringworm was present in 30 males and 34 females, the peakage for occurrence being between 5 and 10 years.Lower lip syndrome first noted by Ingle and later describedby Daynes,4 is debilitating mainly from an irritative and cosmeticpoint of view. Eleven cases (6 in males) were seen, moreoccurring in the urban group, than the other two at ages between40 and 49 years.Diseases of the genito-urinary system (3, 1% ofall diseasesamong males and 10,7% a.mong females). This category was 8thin importance among males and 4th among females. Salpingo-oophoritis and disorders of menstruation were prominent, whilethe rarity of kidney and bladder stones is notable.SA MEDICAL JOURNAL VOLUME 63 9 APRIL 1983 569TABLE 11. TOTAL NUMBER OF DISEASES IN EACH CATEGORY IN ORDER OF FREQUENCY, SHOWING PERCENTAGE OF TOTALDISEASES IN EACH AGE GROUP - MALESAge (yrs)0-9 10 - 19 20 - 49 50 - 69 70+ TotalDisease No. % No. % No. % No. % No. % No. %Digestive 819 29,3 37 8,8 50 8,3 27 9,0 6 5,8 939 22,2Communicable 629 22,S 77 18,3 122 20,2 68 22,7 19 18,3 915 21,7Respiratory 622 22,2 65 15,5 109 18,1 45 15,0 14 13,5 855 20,2Skin and cellular 227 8,1 47 11,2 35 5,8 12 4,0 3 2,9 324 7,7Trauma 66 2,4 101 24,0 116 19,2 23 7,7 10 9,6 316 7,5Nutritional 144 5,1 9 2,1 18 3,0 11 3,7 3 2,9 185 4,4Ear 119 4,3 19 4,5 9 1,5 7 2,3 1 1,0 155 3,7Genito-urinary 27 1,0 26 6,2 50 8,3 22 7,3 5 4,8 130 3,1Eye 32 1,1 8 1,9 11 1,8 13 4,3 5 4,8 69 1,6Circulatory 8 0,3 6 1,4 13 2,2 24 8,0 15 14,4 66 1,6Bones and joints 6 0,2 6 1,4 19 3,2 19 6,3 5 4,8 55 1,3Nervous system 14 0,5 6 1,4 19 3,2 6 2,0 3 2,9 48 1,1Mental disorders 3 0,1 2 0,5 10 1,7 6 2,0 9 8,7 30 0,7Allergies 13 0,5 2 0,5 10 1,7 2 0,7 27 0,6Neoplasms 1 0,0 7 1,2 10 3,3 6 5,8 24 0,6Blood diseases 7 0,3 3 0,7 1 0,2 2 0,7 13 0,3Endocrine 1 0,0 2 0,5 3 0,5 3 1,0 9 0,2Congenital malformation 10 0,4 4 1,0 1 0,2 15 0,4Diseases of early infancy ~ 1,8 50 1,2Subtotal 2798 420 603 300 104 4225Undiagnosed -M ...1i ~ ....IL 1 165Total 2882 434 642 327 105 4390TABLE Ill. TOTAL NUMBER OF DISEASES IN EACH CATEGORY IN ORDER OF FREQUENCY, SHOWING PERCENTAGE OF TOTALDISEASES IN EACH AGE GROUP - FEMALESAge (yrs)0-9 10 - 19 20 - 49 50 - 69 70+ TotalDisease No. % No. % No. % No. % No. % No. %Respiratory 600 22,2 207 29,3 365 20,0 160 29,0 15 11,6 1 347 22,8Digestive 761 28,1 67 9,5 185 10,2 54 9,8 11 8,5 1 078 18,2Communicable 663 24,S 95 13,5 205 11.3 77 13,9 14 10,9 1 054 17,8Genito-urinary 11 0,4 94 13,3 491 27,0 29 5,2 5 3,9 630 10,7Skin and cellular 237 8,8 89 12,6 103 5,7 21 3,8 3 2,3 453 7,7Nutritional 110 4,1 17 2,4 109 6,0 25 4,5 5 3,9 266 4,5Trauma 41 1,5 51 7,2 110 6,1 22 4,0 5 3,9 229 3,9Ear 121 4,5 22 3,1 26 1,4 5 0,9 174 2,9Circulatory 14 0,5 12 1,7 42 2,3 59 10,7 25 19,4 152 2,6Bones and joints 8 0,3 12 1,7 68 3,7 38 6,9 12 9,3 138 2,3Eye 41 1,5 24 3,4 31 1,7 17 3,1 1 0,8 114 1,9Nervous system 10 0,4 8 1,1 14 0,8 13 2,4 13 10,1 58 1,0Neoplasms 4 0,1 1 0,1 24 1,3 14 2,5 6 4,7 49 0,8Mel"tal disorders 5 0,2 1 0,1 11 0,6 5 0,9 12 9,3 34 0,6Blood diseases 10 0,4 3 0,4 17 0,9 2 0,4 1 0,8 33 0,6Allergies 6 0,2 14 0,8 8 1,4 1 0,8 29 0,5Endocrine 2 0,3 2 0,1 4 0,7 8 0,1Congenital malformation 8 0,3 1 0,1 1 0,1 10 0,2Diseases of early infancy 54 2,0 54 0,9Subtotal 2704 706 1 818 553 129 5910Undiagnosed --1.Q.1. ~ --ill. ....R. _6 420Total 2808 764 2033 590 135 6330Trauma comprised mainly physical injuries, with a relatively cases and may be obscured by the severity of the presentingsmall incidence of poisoning. Trauma was the most common illness.diagnosis in males in the IO-19-year age group. Kv:ashiorkor (44, 1% in males and 17,7% in female ). Manypatients with this diagnosis were under 2 year old. It wa theNutritional diseases (4,4% of all diseases among males and most common disease in thi category recorded for the males of4,5% among females). The actual prevalence is considered to be the urban group, and was twice as common in the 'blanket' grouphigher than recorded because it is dealt with by nurses in some as in the 'school' group.570 SA MEDIESE TYDSKRIF DEEL 63 9 APRIL 1983Pellagra (15,9% in males and 43,8% in females) is a disease ofmaize-eaters, parricularly of females (71 % of cases), since theyare handicapped by cusroms which debar them from eating eggsand from drinking milk at certain times.Malnlllrition: 131 cases were recorded, 63 in males and 68 infemales.J'v1araslnus (14 cases) was included under diseases of earlyinfancy.Obesity was present in 31 patients, all but 2 being female; 6were urban and 21 in the 'school' group.Diabetes was found in only I 'blanket' male, 6 'school' and 4urban patients.Diseases of the ear (3,7% of all diseases among males and2,9% among females). Otitis media accounted for the largestnumber of cases here. Four deaf mutes were seen.Diseases of the eye (1,6% of diseases among males and 1,9%among females). Conjunctivitis and ophthalmia were the mostcommon seen.Diseases of the circulatory system (1,6% of all diseasesamong males and 2,6% among females). Cardiomyopathies wereresponsible for 46% of the cases in males and 32% of those infemales. The incidence was higher in the 'blanket' and 'school'groups. The roral number of males with hypertension andhypertension-induced heart disease was 5 (7,6% of the roralnumber of males with diseases of the circulatory system), 2 ofthese belonging to the 'blanket' group and 3 to the 'school'group. The corresponding figures in females are: total 40(26, I%), 10 'blanket', 26 'school' and 4 urban. Most remarkableby their absence were angina pectoris and coronary thrombosis.Varicose veins were rarely seen and no cases of pulmonaryembolization or piles were seen. Rheumatic heart diseaseconstituted only _ 5% of the cases seen in this category.Diseases of early infancy. Immarurity was responsible formost cases, followed by difficulties in feeding, marasmus andumbilical sepsis.Blood diseases. All cases were of hypochromic anaemia, thisthought ro be due to iron deficiency, and all were responsive totreatment.Allergies. Asthma was the most frequent diagnosis here.Neoplasms. Cancer of the oesophagus was the commonesttumour seen (57,1% in males and 14,3% in females). Nomalignant neoplasms of the buccal cavity and pharynx, colon,rectum, liver, thyroid, ovary, fallopian tubes or bone, and nocases of Hodgkin's disease or leukaemia were recorded.Diseases of the bones and joints. The most commonfindings here were rheumatism and arthritis (48,7% in males and45,4% in females).Diseases of the nervous system. Epilepsy (50% in malesand 31, I% in females), cerebral stroke and other vascular lesionsof the central nervous system (12,5% in males and 22,4% infemales) and meningitis (4,2% in males and 13,8% in females)were the most common diagnoses.Mental disorders. More than half of the patients (± 70%)seen in this category were in the 'blanket' group. The maindiseases were senility (30% in males and 38% in females), an~ietystates (13% in males and 8% in females), and alcoholism andalcoholic psychosis (7% in males and 11% in females). The mostcommon diseases associated with mental disorders were thecardiomyopathies.ConclusionThe commonest diseases were gastro-enteritis (1600 cases) andtuberculosis (900 cases). Tuberculosis is still a major fatal diseaseamong adults, although there is evidence that it is being broughtunder control. Gastro-enteritis (often fatal) was the mostprominent complaint among children. There was an unusuallyhigh incidence of cancer of the oesophagus.REFERENCES1. Rose E, Dames WG, Kloppers PJ.A 5,,'1''.v ofDisease Parrems in T ranskei andche Ciskei (Universiry of Preroria New Series No. 146). Preroria: Van Schaik,1980.2. Palmer PES, Daynes WG. Transkei silicosis. 5 Air Med] 1967; 41: 1182-1188.3. D:~lnes WG. The prevention of Transkei silicosis. S Air Med] 1973; 47: 352-3:>:>.4. Daynes WG. Lower lipsyndrorne - a form oflupuseryrhemarosus? 5 AirMed] 1973; 47: 310.

Disease patterns in Transkei and Ciskei

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Disease patterns in Transkei and Ciskei

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